Every second counts when it comes to stroke treatment. Once a stroke starts, 1.9 million brain cells may die each minute until the blood supply to the brain is reestablished. That's where telestroke comes in. What is telestroke? It's an approach that finds the right balance between getting to the closest hospital and having access to world-class expertise in stroke treatment.
A Need for Better Services
Stroke treatment has come a long way in the last 20 to 25 years. While new medications and surgical options have changed the outlook for many stroke patients, time is still critical, as is an accurate diagnosis and assessment.
"Time is brain," says Lucian Maidan, MD, Regional Medical Director of Stroke and Vascular Services at the Dignity Health Neurological Institute and neuroendovascular surgeon at Mercy Medical Group, a service of Dignity Health Medical Foundation. "When stroke occurs, you want to go to the closest hospital."
People having a stroke need to go to the closest hospital available, but many also need specialized expertise and technology to get the best outcome. Not every hospital has a primary stroke center, let alone a comprehensive stroke center that's equipped with the latest technology and staffed by highly experienced specialists in stroke care.
"Some smaller hospitals don't have a vascular neurologist or sometimes any kind of neurologist on-site," explains Dr. Maidan. Fortunately, there's a solution.
The Advent of Telestroke Services
The Dignity Health Neurological Institute developed the telestroke model in 2006 to bring the expert stroke care of large hospitals to smaller, more remote centers. The system now includes 23 sites. With a total staff of 17 neurologists, at least three stroke experts are on call at any given time to advise clinicians on the front lines.
Using high-quality videoconferencing and image sharing, telestroke connects small hospitals to a vascular specialist within five minutes.
"The system allows us to see the patient, see the CT scans, and make recommendations on treatment," says Dr. Maidan. On-site physicians can start life- and brain-saving tPA as soon as possible, or arrange fast transport to the nearest specialty center for mechanical treatment.
The Importance of Experience
There are two main types of stroke. Ischemic strokes are caused by a blood clot that blocks the passage of blood to the brain. In a hemorrhagic stroke, a burst blood vessel interrupts the flow of blood to the brain. The symptoms are similar, but the treatments are very different. Diagnostic imaging shows the type of stroke and the location of the blockage, which help doctors determine the most effective treatment.
For most ischemic strokes, the experts will recommend tPA administered intravenously to dissolve the clot. It must be administered within the first three hours after stroke onset to get the best results — that's why reaching the closest hospital is key. In a hemorrhagic stroke, new options include surgical removal of the blockage using a tool called a stent retriever. This cutting-edge stroke treatment, called thrombectomy, requires the skill and experience of highly specialized clinicians.
So what is telestroke? For people who are experiencing a stroke, it can be the difference between life and death. The telestroke model of health care delivery has been so effective, it is now spreading to other specialties, offering new hope to more patients.